Project Evie - Falls Clinic Redesign



The Sheffield Falls Service is a tiered city wide service which aims to reduce falls and subsequent injury, especially of older people, in Sheffield.  This project aimed to improve the quality of the level 3 specialist hospital based part of the service.


  • Frail older patients complained of being exhausted by the whole day of multidisciplinary assessment
  • 25% of patients were considerd to be inappropriate for the clinic after assessment, eg. those with severe dementia


The Approach

The MDT took on the improvement work, and set up a series of regular meetings to assess, diagnose and treat the problems in thier service.  Ownership came from the team.

The team approached Service Improvement who provided a microsystem coach to help them with the work.

A virtual patient - Evie was defined (see across) - This use of a virtual patient to help keep the patient central to the redesign work was initial devised by the Ester project in Sweden.

Using the microsystem 5Ps framework the coach and team assessed the system.  The clinic processes were mapped, patient and process cycle times were recorded and spaghetti diagrams of the patients motion around the clinic were plotted.

Cycle times


Following this diagnosis of the system using the 5Ps the team set themselves two specific aims -

  • To reduce the time in clinic for each patient attending the multidisciplinary falls clinic assessment by 50% by August 2011

  • To decrease the percenatge of innapropraite patients attending the falls clinic to less than 5% by August 2011


Treating the System

The team generated ideas for improvement based on their data and process map.  They then tested these ideas using the model for improvement.  This involved iteratively increasing the scale of the tests based on the confidence gained in initial small scale tests often with a handful of patients in one clinic.

Process Map

 Process map


  • Clinic flow and processes - from push to pull

  • MDT documentation - standardisation

  • Referral Process - removal of waste

  • Introduction of a pre clinic Occupational Therapy home visit - home hazard aseesment and screening

Patient Flow


DRU run chartThe median time patients spent in clinic reduced from 380 minutes to 155 minutes and the whole day service now only takes half a day.

Savings of £48,000 were delivered giving a Return on Investment (ROI) of 5:1

The home hazard assessment visit reduced the number of inappropariate patients seen in clinic to <5%




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